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BMJ Open. 2019 Nov 27;9(11):e025895. doi: 10.1136/bmjopen-2018-025895.

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP).

Author information

1
Institute for Women's Health, University College London, London, UK u.menon@ucl.ac.uk.
2
Research Unit for General Practice, Aarhus University, Aarhus, Denmark.
3
Policy and Information, Cancer Research UK, London, UK.
4
Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
5
Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.
6
Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
7
Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK.
8
Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, UK.
9
The Royal Marsden, London, UK.
10
Institute for Cancer Research, Olso University Hospital, Oslo, Norway.
11
Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
12
Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK.
13
Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
14
Institute for Women's Health, University College London, London, UK.
15
European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway.
16
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
17
Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
18
Regional Oncologic Center, University Hospital, Uppsala, Sweden.
19
North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.
20
Department of Oncology, Lund University Hospital, Lund, Sweden.
21
Population Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
22
Academic Unit of Primary Care, University of Leeds, Leeds, UK.
23
School of Psychology, Deakin University, Geelong, Victoria, Australia.
#
Contributed equally

Abstract

OBJECTIVE:

Differences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.

DESIGN:

Newly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.

PARTICIPANTS:

Consecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Interval lengths (days; primary), routes to diagnosis and symptoms (secondary).

RESULTS:

With the exception of Denmark (-49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012-2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (-11 days) than Wales (20 days); Sweden had shorter (-20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (-13), Manitoba (-11), England (-9) and Northern Ireland (-4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.

CONCLUSION:

There are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.

KEYWORDS:

international health systems; lung cancer; routes to diagnosis; symptomatic presentation; time intervals

PMID:
31776134
DOI:
10.1136/bmjopen-2018-025895
Free PMC Article

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